Some professions just don’t seem to lend themselves to IT-department support. Take nursing, for example. Yes, there’s a fair amount you can do to improve the life of a nurse in a hospital or clinic, but what about those dedicated souls who jump into their cars and roam the province, providing home-care to those in need of medical services? Unfortunately, there’s not a lot you can do for those folks – unless you really put your mind to it.
Meet Roy French, a guy who likes to put his mind to a lot of different things. Readers of CIO Canada were introduced to him in 2000, when he was CIO of pharmaceutical firm Aventis Pasteur, tackling a big multicultural SAP project. Not your average CIO, French was leading a double life as a writer of slam bang thrillers, chronicling the exploits of Irish paramilitary enforcer, The Raven. Since then, he has continued his remarkable output of novels (his tenth, Raven’s Shadow, is now in the hands of his editor), penned a screenplay, and played the role of a detective in the direct-to-video martial arts film The Order of One.
But French’s CIO alter ego is still alive and well. Two years ago, he took over the IT reins at Saint Elizabeth Health Care (SEHC), a not-for-profit organization providing health services “anywhere, any time” in Ontario, from twenty locations across the province. A model employer that has earned numerous kudos as one of the country’s best places to work, Saint Elizabeth employs over 3,700 multidisciplinary staff, most of whom are nurses, and delivers three million home-care visits annually.
Though the organization is nearly a century old, its operational philosophy is as fresh as the Raven’s latest adventure. Saint Elizabeth describes itself as a knowledge and care exchange company, intent on “leading home and community care through innovation and best practices”. That’s where IT comes in, providing the latest in tech support to help SEHC live up to its leading-edge claims.
“Saint Elizabeth has always been known as a healthcare innovator,” said French. “For example, about ten years ago we launched a Web-based learning tool called @YourSide Colleague. We’ve developed our own content for it and we’re now rolling out the tool to all First Nations in Canada.”
Like most organizations, however, SEHC had legacy systems issues that had to be dealt with, and when French joined the organization he set about doing just that. Two areas in particular came in for an overhaul: the communications systems and the healthcare software used to schedule the nurses.
With offices across the province, SEHC found itself using twenty-two different phone systems. This was a situation that needed addressing, and so the organization went through an RFP process, last year inking a five-year $6.5 million deal with Telus, the single largest IT investment Saint Elizabeth had ever made.
“Folks were justifiably nervous about the size of the investment, but in order for us to move forward and do some of the things that we’re trying to do to improve communication for our staff and to get a solid base for the company, we had to change the infrastructure,” explained French.
The deal includes both voice and data and will see all of SEHC’s Internet traffic routed through the Telus data centre. This will allow SEHC to start measuring, tracking and monitoring data. The organization will now have a simple point of control, as opposed to the twenty-two it had in the past.
On the voice side there will also be many benefits. “We’ll now have four-digit dialling right across the company,” said French. “The phones are basically new devices that we can look at taking advantage of later. We’re just putting the infrastructure in place right now so we can communicate to all of our internal office staff simply. It also gives us a single voice mail system, and that’s a big piece for us.”
REPLACING A HOMEGROWN APP
When French came on board SEHC, the nurses scheduling system was a DOS-based application that had been developed in-house. At the time it was built, there wasn’t a good solution on the market, so in-house development was a viable approach. But in the years that followed, better packaged products had been introduced, and French felt that the time was right to move to move away from the internally developed application.
“In terms of moving forward and trying to get something out into the field quickly, it was another two-year endeavour to complete the development of the in-house system, and that wasn’t acceptable,” he said. “So we went out to the market and found a good, solid solution and started the implementation process.”
SEHC opted for Procura, a fully integrated Windows/MS-SQL application supporting administrative, financial and clinical functions for home care. The application has the fundamentals of a patient-health record, and is run by the coordinators in the delivery centres. It provides tools to document clinical decisions and help users communicate with co-workers.
SEHC now has consistency of data across the company for its healthcare software, giving it the enhanced ability to analyse what is going on in the business.
Part of French’s goal is to make life easier for SEHC’s nurses. In order for him to get a better feel for what their job is like, he accompanied some of them on their rounds. Starting at eight o’clock in the morning, he would travel with them from client to client – first to a wound-care patient, for example, then to a palliative care patient, then to a dialysis patient, and then to a chemo patient.
French did this in both an urban and a rural setting in order to find out what nurses in each type of area had to deal with.
“It really gave me a tremendous insight into their challenges in terms of the manual process they have to follow. And they are not shy about telling you what their pain points are and how we can help them,” said French. “But they do appreciate you coming out and talking to them. And I try to encourage all the IT staff to get out and do site visits as well.”
One of the ways French and the IT team are helping both nurses and support staff is by reducing their paperwork. In the past, service delivery coordinators faxed the nurses their schedule for the following day. At the end of the day the nurses would have to fill out the daily service plan, recording the time they visited each client and the nature of the support care, and fax it back to the coordinator, who would then have to reenter the data so that it could be used in the billing process.
An IVR system called “Call Me” now allows nurses to phone in when they get to the client’s home and phone when they leave. That sets up the system automatically so that the visit can be confirmed in Procura and then billed. The process is automatic and replaces all the paperwork that used to go on in the past. What’s more, if there’s any dispute as to whether or not the nurse showed up for a patient visit, the system can confirm that the calls came from the client’s home.
Down the road, the system might also be used to automate the billing process, so that as soon as the visit was made, the billing process could start.
“We have the capability of doing that,” said French. “There’s no real requirement for it now, but if in the future we get into more private billing [e.g., of insurance companies], it would be good to have that capability.” With the tablet, the nurse can take a photograph, get it into a document, and wirelessly communicate it back to the wound specialist in the office, who can do an assessment.
TAKE ONE TABLET
French is hoping that another piece of enabling technology will soon be in the hands of SEHC’s nurses. The company is one of the first in Canada to get its hands on the new clinical assistant C5 tablet PCs from Motion Computing of Austin, Texas. These are now being evaluated for use in patient charting in the client’s home.
Today, nurses write client assessments – sometimes 10 or 15 pages long – on paper forms before they go to the client’s home, usually doing the work the night before. With the tablet, all they have to do is log onto the system in the morning before they start on their rounds, key in the client’s ID number and retrieve the data from the healthcare software system. Then they decide which of the forms they’re going to fill out, whether it be an initial assessment or and on-going assessment, and that form will be displayed on the tablet.
“It’s a wireless solution that gives us the ability to look at client outcomes in terms of treatments – how long a wound-care takes to heal with a particular type of dressing, for example. So we can do good analysis,” said French. “If we want to do that today it requires someone to pull the charts from the client’s home, then manually enter all the data that’s kept in these forms.”
Once in the client’s home, the nurse can work online wirelessly, or if there is no wireless access, they can work offline and then connect wirelessly as soon as there’s a signal, without the nurse having to interact with the system.
“We don’t expect the nurses to be technology folks,” said French. “We want to make this a wonderful, seamless experience for them.”
A PICTURE OF HEALTH
One of the key clinical features of the new tablet is the ability to take photographs. The device is equipped with a camera and a light source built into the back.
SEHC has already experimented with a photographic system for wound-care applications, using a laptop PC and a camera, but the process is too cumbersome. It took a long time for the laptop to power up and for the nurse to get the camera to work. When the photograph was finally taken, it would be downloaded to the laptop via a USB cable. The picture would then be attached to the wound-care application, which a specialist at the office would eventually look at. There was no wireless connectivity or real-time assessment. With the tablet, the nurse can take a photograph, get it into a document, and wirelessly communicate it back to the wound specialist in the office, who can do an assessment. The assessment can then be wirelessly communicated back to the nurse in the client’s home, so that an appropriate action can be taken.
“If we can do the assessment that fast, it may shorten the time for the wound to heal,” said French. “So it’s all about focusing on the client – better treatments, better healing times.”
Another benefit of the tablet is its small size and flat profile. As French noted, when nurses flipped up the screens of their laptop PCs in front of their clients, it created a psychological and physical barrier. With the tablet, there is just a slate that the nurses hold in their hands and write on. It gives the impression of openness.
COPING WITH CHANGE
French recognizes that the organization will have to focus on change management if this initiative moves forward.
“You’re going from a nurse who has a whole bunch of pieces of paper and a pen, to a tablet. It’s a radical change, like going from the Dark Ages to the leading edge,” he said.
French is keeping tabs on early adopters of the tablet in the U.S. to find out what their experience has been. One thing he discovered is that U.S. users wanted a keyboard to enter the data. And to sell the solution and move it forward, IT organizations accommodated these users by giving them docking stations. Within eight months, though, the keyboards weren’t being used.
Taking a lesson from this, French may look at trying to get users comfortable without keyboards, or provide only a few docking stations to begin with, removing them over time.
He also plans to use peer pressure to help sell the concept. “Some of the nurses here are excited about technology and we’ll let them try it and be ambassadors for us,” he said.
In the end, he believes that the tablet’s effectiveness will win the day. “I think the nurses will be very accepting of the solution given the fact that it’s going to eliminate a lot of the drudgery of paperwork that they do on their own time,” he said.
BUILDING THE ELECTRONIC CHART
An electronic charting solution is also a key part of SEHC’s IT agenda. That means taking all the forms in use today – assessment forms, patient progress forms, and anything else that is on paper – and converting them to digital.
“I want to get away from the concept that it’s just an electronic form. It’s actually a repository for the data so we can store it electronically in a database and then use that to get real-time, standardized clinical information,” said French. “Today if we want to do this we have to retrieve the client’s charts and key the data in Excel spreadsheets. It’s difficult to do and there’s no consistency of data.”
“There are only so many locations on the human body,” he said, “so can we make the data table-driven? We’re working with our clinical folks to do this – trying to get the mindset around shifting from a paper-based collection of data to an electronic one.”
More effective data collection, in all its forms, will enable SEHC to take the next important IT step: the use of Business Intelligence.
“We have a large amount of data today with our Procura healthcare solution, and when we get the smart chart in place we’ll have a huge amount more. Now we’ve got to figure out how to best utilize that data,” said French. “We’re starting to look at developing a business intelligence strategy and introducing some intelligence tools to give our senior managers at head office and the managers in the service-delivery centres the indicators that they need regarding such things as productivity and what’s going right or wrong.”
However, the business intelligence piece is just in its infancy, stressed French.
With a nursing shortage in Canada, French believes that SEHC’s strong commitment to innovative IT-based solutions will help the organization compete for talent.
“Nurses coming out of university will be accustomed to new technology, and I think their ability to use these new tools and techniques will be a real selling feature for us,” he said.
In the end, he added, SEHC’s innovations are all around making the nursing experience as pleasant as possible, without being intrusive. And of equal importance, they are around making the client experience as positive as possible.
“This is the sharp end of care. When you see how these people are in their homes, and what these nurses do, it’s very humbling,” he said. “And you really want to improve both the client experience and the nurse’s experience, because the next visit could be your mother, your daughter, your father, your son. That’s the mental model I try to have everyone in our IT organization picture.” 078746
David Carey is a veteran journalist specializing in information technology and IT management. Based in Toronto, he is editor of CIO Canada.